HURRICANE & DISASTER CONFERENCE

About 300 people attended the 2013 Mid Coast Hurricane & Disaster Conference at the Victoria Community Center. Although scheduled keynote speaker Victor Wells of the Texas Emergency Medical Task Force had to cancel because of the West fertilizer plant explosion, John Metz of the National Weather Service moved from the wrap-up session and gave a preview of the upcoming hurricane season during the lunchtime presentation.

The annual conference is presented by the American Red Cross with participating sponsors and partners.

Peggy Fonseca saw the carnage in front of her that July evening in 2012 and knew immediately that the crash was fatal.

"Triage was simple. They were either red or dead. There was no in between," said Fonseca, the Goliad County Emergency Medical Services director and emergency management director, during a panel discussion on fatality management at the 2013 Mid Coast Hurricane & Disaster Conference.

A pickup carrying 23 people smashed into a tree about 6:30 p.m. July 22 along U.S. Highway 59 in Berclair. Fifteen people, who all entered the country illegally, died in the crash.

The dispatcher at the Goliad County Sheriff's Office got the first hint of the scope of the wreck when the man who called 911 told her there were bodies on the roadway, and "no one's getting up."

The caller then began counting bodies and stopped at six. Fonseca played the 911 call during her presentation.

Twelve different medical and law enforcement agencies - area, state and federal - responded to the scene, Fonseca said.

As paramedics, firefighters and law enforcement did their jobs, new problems arose.

"We start getting calls from the media and from family members," Fonseca said. "As first responders, that becomes the issue.

"We had enough to worry about with bodies all across the road, the responders and traffic. We had to manage all those human remains on the side of the road with dignity. It was very challenging."

Fonseca said by promptly setting up an incident command center to centralize communication and with the assistance of Mary Jane Martin, Goliad public information officer for Emergency Management, and the Texas Department of Public Safety public information officer the onslaught of requests for information were handled without interfering with the rescue and recovery efforts.

First receivers

As the injured were transported from the scene, either by Goliad or Beeville ambulance or by helicopters to Victoria, San Antonio or Corpus Christi, hospitals also faced a challenge.

"We got a call from Goliad EMS saying that there had been a motor vehicle crash with multiple victims," Price said. "We did not know the magnitude of the situation."

She said unfortunately, DeTar and Citizens Medical Center are becoming accustomed to dealing with motor vehicle crashes with multiple victims, usually immigrants who are coming over.

"These are difficult patients to manage because usually they are dying before they are dying - they're dehydrated, they're sick. When they have trauma on top of that, they are difficult patients to manage," Price said.

Initially they were told four patients were coming by ambulance. Then they were told another four were coming via helicopter, DeTar staff responded accordingly.

Still unaware of the magnitude of the wreck, they notified some extra staff, mobilized trauma teams, the operating room and the blood bank and prepared to take care of the trauma patients.

The first two young men arrived about 7:30 p.m.; neither were able to give their names. Thirty minutes later, two more arrived by ambulance, Price said.

"The helicopter never came, and we realized that there had been a communication problem."

With no neurosurgeon on call, three of the patients who needed neurosurgical evaluation were transferred to San Antonio. One was admitted to DeTar, Price said.

"Only getting four patients was a bit of relief, so this in and of itself was not the disaster," Price said.

"Then the media started calling. They had been told all the victims and all the remains went to Victoria. So, the families also started calling. Miscommunication had occurred," Price said.

The hospital did not know any names, ages or anything, she said, adding that it took until February for the hospital to get complete details on the four patients they treated.

"The media started calling directly to the ER, and we realized that no one had set up an incident command, and no one had called the PIO," Price said.

"Now, the media management of this situation became the disaster," she said. "And trying to deal with families who had lots of questions that we couldn't answer."

Price said in the hospital's after action report, a couple of areas for improvement were identified.

"Having an early awareness of the situation would have triggered mobilization of the PIO and security," she said. "Those of you who work for hospitals, my message to you is stand that stuff up early."

Lessons learned

Fonseca enumerated at least four lessons learned from the Berclair crash.

"Communication, use of a PIO, know your stakeholders and do your first responders stress debriefing early," she said.

There were communication issues between Goliad County and Bee County, something that continues to be worked on, Fonseca said.

"Their dispatcher had to call our dispatcher, who then called us," Fonseca said.

"We got the PIO there quickly and kept the media off of us," she said.

"Know your stakeholders," she added. "We have a good relationship with the hospitals in Victoria; we have a good relationship with the hospital in Beeville. We have a good relationship with the air services, law enforcement, the mortuary services."

Fonseca emphasized that having a critical incident stress debriefing as early as possible after is essential.

"We probably saved a lot of burnout by doing that as quickly as we did."

Fonseca said another lesson learned was establishing a family support center after a major incident.

The Goliad Funeral Home fielded 1,300 phone calls in the two days following the crash, Fonseca said.

"People were begging to come see if it was their family member," she said.

"Our community was also devastated for a bunch of people they didn't even know.

"Not only was it impacting on us as providers, but it was impacting on those we still have to provide for."

Alex Camacho, district coordinator for the Texas Division of Emergency Management, said he was impressed by how the area first responders handled the incident.

"They handled everything very well on their own," Camacho said. "We're starting to think more about the first responders and what impact events like this have on them."